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Peds Ex. 3 Study Material > Cognitive & Sensory Impariment > Flashcards

Cognitive & Sensory Impariment Flashcards

1
Q

What are the diagnostic criteria for CI?

A
  • Subaverage intellectual functioning (IQ = 70 to 75 or below)
  • Functional impairment in at least two adaptive skill domains:
    –Communication
    –Self-care
    –Home living
    –Social skills
    –Use of community resources
    –Self-direction
    –Health and safety
    –Functional academics
    –Leisure
    –Work
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2
Q

What are the most common delays seen in developmental disabilities?

A
  • Language and cognitive skills
  • Fine and gross motor skills
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3
Q

What are the different classifications of CI?

A
  • Educable/mild—IQ 50 to 75
  • Trainable/moderate—IQ 36 to 49
  • Severe—IQ 20 to 35
  • Profound—IQ less than 20
    *
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4
Q

What are early signs suggestive of CI?

A
  • Dysmorphic features (Down’s Syn. Microcephaly
  • Irratibaility or nonresponsiveness to contact
  • Abnormal eye contact during feeding
  • Gross motor delay
  • Decreased alertness to voice or movement
  • Language difficulties or delay
  • Feeding difficulties
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5
Q

Describe primary prevention tips for CI

A
  • Avoidance of prenatal rubella infection—keep immunizations current
  • Genetic counseling, especially regarding risk of Down or fragile X syndrome
  • Use of folic acid supplements (neural tube defects)
  • Education regarding the dangers of smoking or alcohol use during pregnancy and ingesting lead during childhood
  • Reduction of head injuries
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6
Q

What are some secondary prevention tips for CI

A

•Early identification to initiate treatment to avert damage
–Prenatal diagnosis or carrier detection of disorders such as Down syndrome
–Newborn screening for treatable inborn errors of metabolism
•Congenital hypothyroidism
•Phenylketonuria (PKU)
•Galactosemia

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7
Q

What are some tertiary prevention interventions for CI?

A

Treatment to minimize long-term consequences

–Early ID of therapies and rehabilitation services

  • Treatment of coexisting problems
  • Programs for infant stimulation, parent training, preschool education
  • Counseling services to preserve the family unit
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8
Q

What is the goal of care for children with CI?

A

Promote optimum development as individuals within the family or community

Nurse provides guidance
–Assist child in establishing acceptable social behavior, training and referrals
–Promote child’s well-being
•Maintain medical appointments
•Personal feelings of self-esteem, worth, and security

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9
Q

What is the most common genetic cause of CI?

A

down syndrome

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10
Q

How does maternal age play a role with down syndrome?

A

–80% of infants with Down syndrome born to mothers < 35 years old
–Age 35+ incidence approximately 1 in 350
–Age 40+ incidence approximately 1 in 100

The incidence of DS increases as maternal age increases

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11
Q

What are the clinical manifestations of down syndrome?

A
  • Separated sagittal sutures
  • Oblique Palpebral fissures = upward outward slant to eyes
  • **Simian creases **
  • Small nose w/flat nasal bridge
  • High-arched palate
  • Excess skin in neck folds
  • Plantar crease between big and 2nd toe
  • Wide space between big and 2nd toes
  • Hyperflexible
  • Hypotonia/muscle weakness - MAY HAVE PROBLEMS WITH ATTACHMENT
  • Protruding tongue
  • Low set ears
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12
Q

What are some congenital anomalies associated with down syndrome?

A
  • 40% to 45% heart defects: Septal defects (ASD or VSD)
  • Renal, Hirschsprung, tracheoesophageal fistula
  • Altered immune function
  • Musculoskeletal
    • Muscles: Hypotonic
    • Joints: Hyperextensible
    • Atlantoaxial instability: 15%-20%
  • Sensory (hearing loss is common)
  • Growth: weight vs.height (they gain weight more rapidly than they do height)
  • Altered Sexual development
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13
Q

What is atlantoaxial instability?

A
  • Excessive movement between C1-C2
  • Urgent if sudden signs of spinal compression
  • If present, may need to avoid activities stressful to head and neck
  • May require surgical intervention
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14
Q

What is the 2nd most common genetic cause of CI?

A

Fragile X syndrome

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15
Q

What causes fragile X syndrome?

A

Abnormal mutation on lower end of the long arm of the X chromosome

  • Occurs in affected males and females
  • Occurs in carrier females
  • 80% of those affected are males
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16
Q

What are the physical manifestations of a child with fragile x?

A
  • Large head circumference/long face/prognathism/large ears/long palpebral fissures/strabismus
  • Palate—high-arched
  • Mitral valve prolapse
  • Macroorchidism
  • Hyperextensible finger joint, palmar crease
  • Flat feet
17
Q

What are the behavioral manifestations of fragile X?

A
  • Mild to severe CI / Occasional normal IQ with learning difficulties
  • Delayed speech and language
  • Hyperactivity
  • Autistic-like behaviors (can be hand in hand with autisism)
  • Aggressive behaviors
18
Q

How would you manage a child with fragile X?

A

•Tegretol/Prozac—behavioral control
•Stimulants for hyperactivity (similar to ADHD management) – adheral
Mimic behavior—“mainstream management”

19
Q

What are some causes of hearing impairments?

A
  • Anatomic malformation
  • Low birth weight
  • Ototoxic drugs (Lasix)
  • Chronic ear infections (otitis media [OM])
  • Perinatal asphyxia
  • Perinatal infections
  • Prenatal substance use/abuse
  • Cerebral palsy
20
Q

Conductive hearing loss occurs where?

A

Middle ear

21
Q

Sensorineural hearing loss occurs how?

A

Vestibular / cochlear nerve damage

22
Q

What are some Therapeutic Interventions for the 2 different types of hearing loss?

A

Conductive defects
–Medication (antibiotics) – if it is otitis media
–Hearing aids to amplify sound

Sensorineural
–Hearing aids not beneficial
–Cochlear implant may be beneficial

23
Q

What are the Manifestations of Hearing Impairment in Infancy?

A
  • Lack of startle reflex
  • Absence of babbling by age 7 months
    • They should be babbling by at least 4 months
  • General indifference to sound
  • Lack of response to spoken word
  • Newborn hearing screen, birth-3 wks.
24
Q

What are some Perinatal or postnatal infections that can cause visual impairments

A

Gonorrhea, Chlamydia infection, rubella, syphilis, toxoplasmosis

25
Q

Why is myopia?

A

near sidedness, can see close but not far away

26
Q

What is hyperopia?

A

Farsightedness, normal for kids. They might not be able to identify this problem until they are older

27
Q

What is amblyopia?

A

Reduced visual acuity in one eye despite optical correction, aka lazy eye

28
Q

What are the clinical manifestations of myopia?

A
  • Excessive eye rubbing
  • Head tilt or forward head thrust
  • Difficulty reading or doing other close work
  • Reading with books held close to eyes
  • Clumsiness; walking into objects
  • Blinking more that usual
  • Inability to see objects clearly
  • Dizziness
  • Headaches
  • Nausea after doing close work
    *
29
Q

What are the clinical manifestations of amblyopia?

A
  • Poor vision in affectd eye
30
Q

What are the clinical manifestations of strabismus (cross eye’d ness)?

A
  • Squinting of eyelids together or frowning
  • Difficulty in focusing from one distance to another
  • Inaccurate judgment in picking up objects
  • Inability to see print or moving objects clearly
  • closing of one eye to see
  • Tilting of head to one side
31
Q

How would you prevent conjunctivitis and how would you treat it?

A

Prevention:

  • Good hand washing, don’t share towels, wash pillow cases, clean eye drainage.
  • Infection control concerns

Tx:

  • Ophthalmic antibiotics
  • Systemic antibiotics in some cases
  • Caution with use of steroids—may exacerbate viral infections
32
Q

By when should we expect binocularity?

A

by age 6 months

33
Q

What are some interventions for a hyphema?

A
  • Apply Ice for the 1st 24hrs
  • Have child rest with eyes closed
34
Q

What are some nursing interventions for penetrating eye injuries?

A
  • take child to ER
  • never remove the object yourself
  • follow strict aseptic technique
  • apply fox shield to affected eye and regular patch to unaffected eye
  • don’t rub the eye
35
Q

What is a historic cause of hearing and visual impairment in children?

A

Congenital rubella syndrome

36
Q

What is the diagnostic criteria for an autistic disorder?

A
  • Qualitative impairment in social interaction (need atleast 2 of these)
  • Qualitative impairments in communication (needs atleast 1 of these)
  • Restricted repetitive and stereotypical patterns of behavior, interests, and activities (atleast 1)
  • Delays or abnormal functioning with onset before 3 years
37
Q

What are some characteristics of autistic spectrum disorders?

A
  • Etiology unkown
  • ASD usually appears from 18 to 36 months of age
  • Four times more common in males
  • Encompasses autistic disorder, Asperger syndrome, and pervasive developmental disorder–not otherwise specified

COMMON SIGN = LACK OF EYE CONTACT, NOT RESPONDING TO NAME, no one word by 2 months, 2 words by

Peds Ex. 3 Study Material (5 decks)

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